Zhang Yuan, Akl Elie A, Schünemann Holger J
Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada.
Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Lebanon.
Res Synth Methods. 2019 Sep;10(3). doi: 10.1002/jrsm.1313. Epub 2018 Jul 14.
Systematic reviews are essential to produce trustworthy guidelines. To assess the certainty of a body of evidence included in a systematic review the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group has developed an approach that is currently used by over 100 organisations, including the World Health Organization and the Cochrane Collaboration. GRADE provides operational definitions and instructions to rate the certainty of the evidence for each outcome in a review as high, moderate, low, or very low for the effects of interventions, prognostic estimates, values and preferences, test accuracy and resource utilization. The assessment includes assessing risk of bias, imprecision, inconsistency, indirectness, and publication bias, the magnitude of effects, dose-response relations and the impact of residual confounding and bias. Summary statistical information and assessments of certainty are presented in GRADE evidence summary tables, which can be produced using GRADE's official GRADEpro software tool (www.gradepro.org/). The evidence summary tables feed into the GRADE Evidence to Decision frameworks which guideline panels can use to produce recommendations.
系统评价对于制定可靠的指南至关重要。为了评估系统评价中所纳入证据的确定性，推荐分级评估、制定与评价（GRADE）工作组开发了一种方法，目前有100多个组织采用该方法，其中包括世界卫生组织和考克兰协作网。GRADE提供了操作定义和说明，以便将评价中每个结局的证据确定性评为高、中、低或极低，用于干预效果、预后估计、价值观和偏好、检验准确性及资源利用等方面。评估内容包括评估偏倚风险、不精确性、不一致性、间接性和发表偏倚、效应大小、剂量反应关系以及残余混杂和偏倚的影响。确定性的汇总统计信息和评估结果呈现在GRADE证据汇总表中，该表可使用GRADE官方的GRADEpro软件工具（www.gradepro.org/）生成。证据汇总表纳入到GRADE证据到决策框架中，指南制定小组可利用该框架来制定推荐意见。
